<form role="form" method="POST" id="freeSubmitForm"
	action="order.do?submitFreeOrderInfo" class="new-improved-form"
	enctype="multipart/form-data">

	<div class="col-sm-12">
		<div class="form-group">
			<label for="edit-title-1">Name: *</label>
			<input type="text" id="Name" name="name" placeholder="Name" class="form-text form-control" />
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="edit-title-1">Phone:</label><input type="text" id="Phone"
				name="phone" placeholder="Phone" class="form-text form-control" />
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="edit-title-1">Email: *</label><input type="text"
				id="Email" name="email" placeholder="Email"
				class="form-text form-control" />
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="Size">Size:</label><select id="Size" name="size"
				class="form-text form-control"><option value="1">2
					inches</option>
				<option value="2">2.5 inches</option>
				<option value="3">3 inches</option>
				<option value="4">3.5 inches</option>
				<option value="5">4 inches</option>
				<option value="6">4.5 inches</option>
				<option value="7">5 inches</option>
				<option value="8">5.5 inches</option>
				<option value="9">6 inches</option>
				<option value="10">6.5 inches</option>
				<option value="11">7 inches</option>
				<option value="12">7.5 inches</option>
				<option value="13">8 inches</option>
				<option value="14">8.5 inches</option>
				<option value="15">9 inches</option>
				<option value="16">9.5 inches</option>
				<option value="17">10 inches</option>
				<option value="18">10.5 inches</option>
				<option value="19">11 inches</option>
				<option value="20">11.5 inches</option>
				<option value="21">12 inches</option></select>
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="PercentageofEmbroidery">% Embroidery:</label><select
				id="PercentageofEmbroidery" name="embroidery"
				class="form-text form-control"><option value="27">50%</option>
				<option value="28">75%</option>
				<option value="29">100%</option></select>
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="Quantity">Quantity:</label><select id="Quantity"
				name="quantity" class="form-text form-control"><option
					value="30">10</option>
				<option value="31">20</option>
				<option value="32">50</option>
				<option value="33">100</option>
				<option value="34">200</option>
				<option value="35">300</option>
				<option value="36">500</option>
				<option value="37">1000</option>
				<option value="38">2000</option>
				<option value="39">3000</option>
				<option value="40">4000</option>
				<option value="41">5000</option>
				<option value="42">7500</option>
				<option value="43">10000</option></select>
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="edit-title-1">Date needed: </label><input type="text"
				id="Deadline" name="Deadline" placeholder="Deadline"
				class="form-text form-control" />
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<div id="edit-field-fq-image-0-1-ahah-wrapper">
				<div class="form-item" id="edit-field-fq-image-0-1-upload-wrapper">
					<label for="File">Image Upload:</label>
					<div class="filefield-upload clear-block">
						<input style="width: 68%" type="file"
							class="form-file wmds-form-file" id="imageFile" name="imageFile" />
					</div>
				</div>
			</div>
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="edit-title-1">AlternativeEmail</label><input type="text"
				id="AlternativeEmail" name="form[AlternativeEmail]"
				placeholder="AlternativeEmail" class="form-text form-control" />
		</div>
	</div>
	<div class="col-sm-6">
		<div class="form-group">
			<label for="Notes">Notes: </label>
			<textarea cols="60" rows="1" id="Notes" name="notes"
				placeholder="Notes" class="form-textarea  resizable form-control"></textarea>
		</div>
	</div>
	<script type="text/javascript">
													$('#AlternativeEmail')
															.parent().parent()
															.addClass('TopTd');
												</script>

	<div class="clearfix"></div>

	<div class="col-md-12">

		<div class="clearfix"></div>

		<div class="center-submit">

			<input name="button"
				class="btn btn-warning submit-blue-form btn-lg btn-block"
				id="button" value="Give me your best price" onclick="return check_valid1();" type="submit">

		</div>

	</div>

</form>